What are the contraindications to Vancomycin (vancomycin hydrochloride)?

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Last updated: February 6, 2025View editorial policy

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From the Guidelines

Vancomycin is contraindicated in patients with a known hypersensitivity to vancomycin.

Contraindications

  • Hypersensitivity reactions: Vancomycin should not be used in patients who have a history of hypersensitivity reactions to vancomycin, such as anaphylaxis, red man syndrome, or Stevens-Johnson syndrome.
  • Pregnancy and lactation: Although vancomycin is generally considered safe in pregnancy and lactation, it should be used with caution and only when the benefits outweigh the risks 1.

Special considerations

  • Renal impairment: Vancomycin should be used with caution in patients with renal impairment, as it can accumulate and increase the risk of nephrotoxicity 1.
  • Ototoxicity: Vancomycin can cause ototoxicity, and patients should be monitored for signs of hearing loss, especially when used in combination with other ototoxic agents 1. Note that the provided evidence does not explicitly state the contraindications of vancomycin, but based on general medical knowledge, the above contraindications can be inferred.

From the FDA Drug Label

Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic. The contraindication to Vancomycin (vancomycin hydrochloride) is:

  • Hypersensitivity to the antibiotic, as stated in the drug label 2.

From the Research

Contraindications to Vancomycin

The following are contraindications to vancomycin:

  • Hypersensitivity to vancomycin 3, 4, 5
  • Patients with known history of vancomycin-induced nephrotoxicity or ototoxicity 3, 4, 6, 5
  • Patients with renal dysfunction, as vancomycin can exacerbate kidney damage 4, 6, 5
  • Patients with hepatic dysfunction, as vancomycin can affect liver function 4
  • Patients with compromised bone marrow function, as vancomycin can cause neutropenia 3, 5
  • Patients with a history of red man syndrome, a hypersensitivity reaction to vancomycin 3, 4, 5

Special Considerations

  • Vancomycin should be used with caution in patients with:
    • Hypertension or diabetes, as these conditions can increase the risk of side effects 4
    • Prolonged therapy, as this can increase the risk of nephrotoxicity and treatment failures 3, 6
    • High blood concentration trough levels, as this can increase the risk of nephrotoxicity 4
  • Vancomycin should not be used alone in enterococcal endocarditis, as it is not effective against these organisms 7

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

The use of vancomycin with its therapeutic and adverse effects: a review.

European review for medical and pharmacological sciences, 2015

Research

Vancomycin revisited - 60 years later.

Frontiers in public health, 2014

Research

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice.

Clinical and experimental pharmacology & physiology, 2019

Research

Vancomycin.

Mayo Clinic proceedings, 1977

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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